Case Report of a 17-Month-Old Toddler: Cyanotic Episodes: Cardiac or Epileptic Seizure?

Background: Bathing epilepsy is a very rare form of reflex epilepsy. Seizures were usually of focal onset in rare cases even evolution to bilateral tonic–clonic seizures were observed. In literature we, differentiate between “hot water epilepsy (40–50°C),” bath epilepsy on diving into water of body temperature (36–38°C), and bath epilepsy triggered by lukewarm water (<36°C). Affected individuals may show genetic changes, in particular at the SYN1 gene, as well as interictal changes, in particular upon sleep EEG. Concerning our case, awake, as well as sleep EEG, and extensive genetic testing were nondescriptive. Avoiding known triggers usually controls seizures, but carbamazepine, valproate, and levetiracetam were also helpful. The prognosis regarding seizure free intervals is stated as good in the given literature. In the case of our patient, we were able to avoid further seizures by avoiding baths.

Method: Provocation of the mentioned episode by bathing in water (temperature: 35–38°C) and documentation via monitoring.

Result: Seconds after sitting the 17-month-ld patient into the tub, he presented a clinical seizure of behavioral arrest, absence, and cyanosis (saturation < 70%), as well as buccal automatism.

Conclusion: It is important to exclude cardiac causes in clinical presentations like this while keeping the differential diagnosis of a bathing epilepsy in mind.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
28 October 2021